Pursuing a Deadly Opportunity

Cadavers are a necessity for medical students and researchers, but the business of supplying this market is a touchy moral and ethical issue. Harvard Business School professor Michel Anteby and research associate Mikell Hyman explore strategies used by both academic and entrepreneurial organizations that deal in the dead. Key concepts include:

The study raises general questions around what constitutes organizational legitimacy and the kind of moral order we want to create as a society.

The same issues could help us come to grips with the murky legal and ethical areas surrounding the digital age.

Understanding how and why these market dynamics develop will shed light on how the supply of cadavers could be increased and improved.

by Julia Hanna

There is a market for everything—even dead bodies. Medical students use cadavers to gain experience, and their future patients are better off for it.

Traditionally, cadavers have been obtained through university programs, but now entrepreneurial ventures are springing up to meet the growing demand for cadavers in medical training, in medical research, and for the development of new medical devices.

Given the sometimes uneasy feelings around the topic, it's easy to understand how such entrepreneurial organizations (both for-profit and nonprofit) could make some people apprehensive, even raising instinctive fears of bodysnatchers looking for a quick payday.

It's just these kinds of gray zones that HBS assistant professor Michel Anteby likes to research, areas where questions of legitimacy and moral beliefs are raised. "Having a cadaver for a medical student to practice on is something we like to see happen, but few really want to know how the cadaver was procured," he says.

In "Entrepreneurial Ventures and Whole-Body Donations: A Regional Perspective from the United States," Anteby and research associate Mikell Hyman analyze donors and recipients of an academic entrepreneurial venture. The paper, which offers a rare glimpse into an area where little consolidated data is available, is forthcoming in the journal Social Science & Medicine.

"This study happens to focus on cadavers, but it raises more general questions around what constitutes organizational legitimacy and the kind of moral order we want to create as a society," Anteby explains.

The same issues could help us come to grips with the murky legal and ethical areas surrounding the digital age, for example. "We can think of the distribution of music and what kind of ethical markets we want to create, given options of illegal file-sharing and copyright infringement," says Anteby. "Any arena where there are concerns that entrepreneurship would place us in a situation where we're not entirely comfortable." Reproductive science, which has created a robust market for human eggs, sperm, and various infertility treatments, is another example, he adds.

Anatomy of a study

Anteby and Hyman compared 80 voluntary donations and 120 specimen shipping invoices from a pair of Maryland-based organizations: one academic-housed program and a nonprofit entrepreneurial venture. In return for body donations, each organization offered comparable levels of financial assistance covering transportation and cremation costs and returning the ashes when requested.

In their research Anteby and Hyman discovered that there was no noticeable difference between the programs in terms of specimens' sex, marital status, educational levels, and estimated incomes. However, donors to the entrepreneurial venture were younger (65 years old on average, vs. 76 years old) and more likely to have died of cancer (71 percent vs. 21 percent).

"Facing these questions will bring about more transparency, more data, and more collaboration."

Finally, while 93 percent of donors to both programs were white, the entrepreneurial venture attracted a higher percentage of non-white donors (11.2 percent vs. 2.5 percent). Anteby and Hyman speculate that the higher number of minority donors to the entrepreneurial organizations could be explained in part by a distrust of established medical institutions on the part of minorities.

The profiles of organizations receiving the cadavers also showed marked contrasts. Perhaps not surprisingly, the academic program showed a higher number of recipients with educational goals (74 percent vs. 47.5 percent). The entrepreneurial venture had a higher representation of recipients with continuing medical education goals (31.7 percent vs. 26 percent) and catered to medical devices companies (20.2 percent of recipients) while the academic-housed program did not.

"Given the fact that the United States relies on a voluntary system to obtain cadavers, it's important to understand the impact of these organizations on the overall supply," Anteby says.

While it could be assumed that the entrepreneurial venture would be more likely to engage in predatory behavior to obtain donations, it did not attract less educated or less affluent donors, the researchers observe in the paper. There was a higher instance of donors who died from cancer, however, which raises the question of whether or not the parties involved were emotionally distressed at the time of the donation.

Serving a market

The entrepreneurial venture filled a need by providing cadavers to medical device companies and organizations that train doctors in new surgical techniques. These companies often only need part of a body. And unlike many medical schools, they will accept donors who died of cancer.

By catering to different demands in the medical field, the 2 organizations—one academic, the other entrepreneurial—used different strategies to obtain donations, Anteby and Hyman observe. The academic program targeted healthy, older individuals well in advance of their deaths (and only those individuals who lived in the state of Maryland), while the other focused primarily on diseased individuals and their families (who were also able to authorize donations upon death) living both in and out of state.

"Rather than focus on the supply side of the equation—that is, on how to convince more people to make donations—this paper considers the question of how these 2 programs took different yet complementary approaches to meet the different demands of organizations that use cadavers," Anteby says.

Understanding how and why these market dynamics develop will shed light on how the supply of cadavers could be increased, he adds, while improving transparency in an area known to inspire more fear than facts.

"There are many assumptions that can be made around 'gray zone' entrepreneurial ventures that bring up issues of legitimacy and moral order," Anteby says. "Some of these assumptions are probably justified, and some need to be revisited. My hope is that facing these questions more fully will bring about more transparency, more data, and more collaboration across academic and entrepreneurial fields."